Christopher Gagliardi by Christopher Gagliardi
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Traditionally, pregnant women were encouraged to reduce levels of physical exertion due to concerns that exercise could negatively affect pregnancy outcomes (e.g., poor fetal growth, premature delivery, miscarriage, and musculoskeletal injury). However, these concerns have not been substantiated and recommendations by The American College of Obstetricians and Gynecologists (2015) suggest that this approach was overly conservative. Currently, pregnant women are encouraged to accumulate a minimum of 20 to 30 minutes of moderate-intensity exercise on most—if not all—days of the week in the absence of medical or obstetric complications. It is important to consider that if women are new to exercise, they may need to set goals for working up to 20 to 30 minutes of moderate-intensity exercise and that the benefits of being physically active may occur with amounts below this target range. 

Pre-activity screening

The Canadian Society for Exercise Physiology has created a screening tool called the PARmed-X FOR PREGNANCY to use with clients prior to participation in a prenatal exercise program.  This resource provides a convenient checklist for the evaluation of pregnant clients with an interest in beginning or maintaining an exercise program throughout their pregnancy.

General Recommendations for Pregnant Exercisers

Collaborating with pregnant clients during the goal-setting process may help them set realistic goals that focus on self-efficacy, enjoyment, and finding success, while working up to the specific exercise recommendations. Although there are many benefits to beginning or maintaining an exercise program while pregnant (e.g., improving or maintaining physical fitness, reduced risk of gestational diabetes in obese women, weight management, reduced risk of pre-eclampsia and cesarean deliveries, and enhanced psychologic well-being), it is still important for pregnant women to receive a thorough clinical evaluation before starting a new exercise program.

In the absence of any contraindications, pregnant women are encouraged to participate in regular, moderate-intensity physical activity [e.g., zone 1, below VT1 (can talk comfortably), RPE of 3–4 on the 0–10 scale or 12–13 on the 6–20 scale, and 3–6 METs].

Examples of moderate-intensity physical activity include:

  • Walking
  • Swimming
  • Stationary cycling
  • Yoga
  • Pilates
  • Strength training
  • Racquet sports
  • Low-impact aerobics

Examples of exercises that should be avoided during pregnancy include:

  • Contact sports
  • Activities with a high risk of falling
  • Scuba diving
  • Hot yoga
  • Sky diving

 

To assist health and fitness professionals in creating safe and effective exercise programs for pregnant women, the American College of Sports Medicine (2018) has established specific recommendations for the frequency, intensity, time, and type (FITT) of activity that can be used in conjunction with the other guidelines presented in this article. The table below summarizes these recommendations.

FITT

Aerobic

Resistance

Flexibility

Frequency

At least 3-5 days per week

2-3 days per week (nonconsecutive)

At least 2-3 days per week (daily stretching is most effective)

Intensity

Moderate (3-5.9 METs, RPE of 12-13)

Vigorous intensity for women who were highly active prior to pregnancy (≥6 METs, RPE 14-17)

Performed to a point of moderate fatigue with multiple submaximal repetitions

Stretch to point of slight discomfort

Time

Work up to 30 min per day (accumulated) of moderate intensity for a total of 150 minutes per week

Vigorous intensity 75 minutes per week

1-3 sets for all major muscle groups depending on level of experience

10-30 seconds (static)

Type

A variety of well tolerated weight-bearing and non-weightbearing activities

A variety of well tolerated free weight, machine, and body weight exercises

Target each muscle-tendon unit using active, passive, and dynamic forms of stretching

Pregnant women should not exercise if any of the following health conditions are present:

  • Risk factors for pre-term labor
  • Vaginal bleeding
  • Premature rupture of membranes

Fitness professionals should also be familiar with both absolute and relative contraindications to exercise.

Exercise Guidelines for pregnant clients:

  • Do not begin a vigorous exercise program shortly before or during pregnancy.
  • If you have been previously active, continue current program during the first trimester to a maximum of 30 to 40 minutes per day as tolerated.
  • With no previous activity, begin slowly with 15 minutes of low-intensity exercise and gradually increase to 30 minutes.
  • During the second and third trimester, the intensity and duration should be gradually reduced.
    Use the RPE scale rather than heart-rate monitoring.
  • Avoid bouncing while stretching, activities with a high risk of falling, deep knee bends, full sit-ups, double leg raises and straight-leg toe touches.
  • Avoid exercise in the supine position after the first trimester.
  • Avoid motionless postures (e.g., certain yoga positions and the supine position).
  • Avoid exercise in high temperatures and/or high humidity.
  • Modify exercise intensity if post-exercise body temperature exceeds 100° F.
  • Focus on hydration.
  • Utilize extended warm-up and cool-down periods.
  • Walking or running should occur on flat even surfaces.
  • Wear a bra that fits well to support the breasts.
  • Some pregnant women may benefit from a small snack prior to exercise to help avoid hypoglycemia.

Warning signs that warrant stopping an exercise session and physician referral before exercise is resumed:

  • Vaginal bleeding
  • Dizziness
  • Shortness of breath
  • Chest pain
  • Headache
  • Muscle weakness affecting balance
  • Calf pain or swelling
  • Regular painful contractions
  • Amniotic fluid leakage

Postnatal Exercise

Returning to physical activity after pregnancy also has benefits (e.g., improved maternal cardiovascular fitness without affecting milk production or composition of infant growth) and is associated with decreased incidence of postpartum depression. Although some recovery time to regain strength is required, during the initial six weeks following delivery your client could begin to slowly increase physical activity as a means of relaxation, personal time, and regaining a sense of control.  Nursing women should also consider feeding infants prior to exercise to avoid the discomfort associated with engorged breasts.

The following guidelines should be followed with the postnatal client:

  • Obtain physician clearance.
  • Begin slowly.
  • Start with walking several times per week.
  • Avoid excessive fatigue.
  • Wear a supportive bra.
  • Stop session if unusual pain is experienced.
  • Stop session if vaginal bleeding is more than normal.
  • Drink plenty of water.

 

For more details regarding exercise program design and pregnancy, click on the article links below:

Training the Late-term Prenatal Client

Help Your Pregnant Clients Exercise Safely Through the Summer Months

Prenatal fitness modifications

 

References

American College of Obstetricians and Gynecologists. (2015). ACOG Committee Opinion. Washington, DC: American College of Obstetricians and Gynecologists. Retrieved from https://www.acog.org/-/media/Committee-Opinions/Committee-on-Obstetric-Practice/co650.pdf?dmc=1&ts=20180917T1123570985

American College of Sports Medicine (2018). ACSM’s Guidelines for Exercise Testing and Prescription (10th ed.). Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins.

Roy, B. A. (2014). Exercise and special populations. In B. C. Editor, J.S. editor, & G.D Editor (Eds.), ACE Personal Trainer Manual (5th ed.) (561-564). San Diego, CA: American Council on Exercise.